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Bipolar Spectrum Diagnosing and
Differentiating From Depression
Christopher D. Cobbs, M.D.
13 October 2010
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Making the Diagnosis of Bipolar Disorder
Differential Diagnosis
Treatment Options
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Lifetime Prevalence of Major Depression is 15 –
25%
Lifetime Prevalence of Bipolar Disorder is 1%
Bipolar Disorder has Equivalent Prevalence
Between Men and Women
Average Age of Onset for MDD is 40 yo
30 yo for Bipolar Disorder
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Combination of Biologic, Genetic and
Psychosocial Factors
Multiple Theories
1st Degree Relatives of Bipolar Proband Have
Increased Incidence of Mood Disorder
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Must have Manic Episode for a Bipolar
Diagnosis
Elevated Mood Must Last 7+ Days
…or Require Hospitalization
Only One Episode of Mania Required…Ever
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3-4 of The Symptoms Present:
Inflated Self-Esteem or Grandiosity
Decreased Need for Sleep
More Talkative Than Usual/Pressured Speech
Flight of Ideas/Racing Thoughts
Distractibility
Increase in Goal-Directed Activity
Excessive Involvement in Pleasurable Activities
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Recurrent
Mixed
Psychotic Features
Hypomania/Bipolar II Disorder
Rapid Cycling
Catatonic
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5+ of the Follow Symptoms Lasting 2+ Weeks
Depressed Mood (May Be Irritable in Kids)
Diminished Interest in Most All Activities
Decreased Appetite/Significant Wt Loss
Insomnia/Hypersomnia
Psychomotor Agitation/Retardation
Fatigue/Loss of Energy
Feelings of Worthlessness/Excessive Guilt
Difficulty Thinking/Concentrating
Recurrent Thoughts of Death/SI
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Substance Abuse
Personality Disorder
Anxiety Disorder
Malingering
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Psychotherapy (Primarily Depressive Phases)
Pharmacotherapy:
Valproic Acid
Lithium
2nd Generation Antipsychotics
Other Anti-Epileptic Drugs
1st Generation Antipsychotics
Antidepressants